Talk:Schizophrenia

References

The "references" section built incorrectly. You should list all the books used in this article at the bibliography subpage. & then list all the notes like <ref>Name, Year. page number.</ref> within the article. And name the section "Notes"

(Chunbum Park 11:20, 5 January 2008 (CST))

I'm not sure I understand. There are no books used in the article, only journal articles. The reference style I'm following seems fairly standard with other medical articles. If I've missed something here, let me know. Richard Pettitt 00:19, 7 January 2008 (CST)

Oh, books, or scholarly journal articles. 1) ppl want in which page you find the info within the article 2) it takes too much space & gets too complicated to copy-paste author date title chapter title isbn publisher copyright etc. So... all the author title date isbn publisher thing goes on the bibliography page. on the "notes section" within the mainspace article you just have "name, date. pp.x". See Japanese invasions of Korea (1592-1598). (Chunbum Park 15:16, 9 January 2008 (CST))

From what I know, the usual convention is to list which pages the article is found within the journal, but not to list which pages within the article you've found the material. Secondly, the references style I'm using isn't much work at all. Using pubmed.com gives you a PMID number which I plug into a template [1] and it does all the work for me. (Believe me, I'm not about to do more work than I have to.) That's why I'm leaving things the way they are. :) Richard Pettitt 13:39, 18 January 2008 (CST)

WHO study

I believe a WHO study showed that people who had less access to antipsychic meds had a higher quality of life than those who could afford the meds. I'm assuming this is the "in a glass jar" effect of being on meds. I'm not advocating no meds, but i think this data is something that should be mentioned and is significant.

I also believe I read that 2/3 of homeless in Los Angeles are schizophrenic. Tom Kelly 21:39, 14 January 2008 (CST)

Ok, 2/3 seems too high. Tom Kelly 22:14, 15 January 2008 (CST)

I'm not familiar with this WHO study. Could you dig it up? Also, I added a study on the prevalence of schizophrenia among the homeless.Richard Pettitt

Schizophr Bull. 2000;26(4):835-46.

Revisiting the developed versus developing country distinction in course and outcome in schizophrenia: results from ISoS, the WHO collaborative followup project. International Study of Schizophrenia. Hopper K, Wanderling J.

Evidence of differences in illness trajectory in favor of the developing centers was consistently found. Six potential sources of bias are then examined: differences in followup, arbitrary grouping of centers, diagnostic ambiguities, selective outcome measures, gender, and age. None of these potential confounds explains away the differential in course and outcome. We conclude with suggestions for further research, with particular attention to the need for close documentation of everyday practices in the local moral worlds that "culture" refers to.

Pierre-Alain Gouanvic 14:07, 28 January 2008 (CST)

From my reading of the article, it seems the matter of treatment outcomes in developed vs developing is far from clear. I'm not sure what we could add to this article that would be informative... maybe that there's a possible difference in treatment outcomes between developed and developing countries? Suggestions? --Richard Pettitt 21:43, 28 January 2008 (CST)

effect of war on schizophrenia

I believe this would be an important section to the article.Tom Kelly 21:47, 14 January 2008 (CST)

percentage of schizophrenics who chain smoke

can you say self medicate? One of those 2,000+ chemicals in cigarette smoke must be doing something we have not yet discovered. Tom Kelly 21:47, 14 January 2008 (CST)

I added something on cigarettes under the treatment section.Richard Pettitt

I know that one hypothesis, theory, and some preliminary data predict that another chemical in cigarettes may be the chemical they self-medicate with (because nicotine alone doesn't explain the smoking. I will ask around for more info. Tom Kelly 22:10, 15 January 2008 (CST)

Yes, tobacco contains monoamine oxidase inhibitors (harman, or something like that), and clinical research suggested that they are at least in great part responsible for reinforcement of the urge to self-administer tobacco. OTOH, MAOI can cause schizophrenia-like symptoms. There's definitely something to dig here, IMO. The research I have in mind was done in France. Gotta go. Pierre-Alain Gouanvic 13:24, 16 January 2008 (CST)

Neuropharmacology. 2007 May;52(6):1415-25. Epub 2007 Feb 20.

Tranylcypromine enhancement of nicotine self-administration.

Moreover, an increase in extracellular dopamine in the nucleus accumbens was detected, using microdialysis, following nicotine (60 microg/kg) injection in tranylcypromine pre-treated rats. Depending on the time of tranylcypromine pretreatment (20 or 1 h), MAO activity was decreased by 72% and 99% and nicotine intake at day 5 was increased by 619 and 997%, respectively. Taken together, these results indicate that in a stringent self-administration acquisition test, MAO inhibition increases the rewarding effect of low doses of nicotine, possibly via a dopamine-dependent mechanism.

Schizophrenia is an hyperdopaminergic disorder, IMAOs cause dopamine elevations; high dopamine contributes to the reinforcement of tobacco addiction; schizophrenics require lower doses of the IMAO in tobacco to get the reinforcing effect. IMO. Pierre-Alain Gouanvic 19:20, 17 January 2008 (CST)

Schizophrenia is a hyper- and hypo-dopaminergic disorder: mesolimbic and mesocorticol dopamine pathways, respectively. (I should probably get around to adding that to the article). So while what you're saying about nicotine's pharmacological effects are true, I believe that nicotine is consumed in an attempt to raise dopaminergic functioning to reduce negative symptoms, rather than for its pleasurable effects. Ideally I'd like an article that speaks more directly to the connection between nicotine's MAO inhibition action and schizophrenia before adding this to the article. Also, I've never heard of a MAOI-schizophrenia connection. I'd be interested in learning more if you could find that research you've mentioned.Richard Pettitt 13:39, 18 January 2008 (CST)

keyboard.problems...: Drugs of abuse, such as D-amphetamine, cocaine, morphine, or heroin, share the ability to cause addiction in humans and to increase release of dopamine (DA) in the nucleus accumbens...However, animal experiments indicate some discrepancies between the effects of nicotine and those of other drugs of abuse. For example, the stimulation of DA release in the nucleus accumbens after several nicotine injections remains controversial...One of the most striking differences between the effects of nicotine and those of other drugs of abuse concerns its locomotor effects. Although psychostimulants and opiates induce a substantial locomotor hyperactivity both in rats and mice, nicotine is a weak locomotor stimulant in rats and generally fails to induce locomotor hyperactivity in mice at any dose...Our data suggest that MAOIs contained in tobacco and tobacco smoke act in synergy with nicotine to enhance its rewarding effects. PMID: 16395299 Monoamine Oxidase Inhibitors Allow Locomotor and Rewarding Responses to Nicotine sorry...Pierre-Alain Gouanvic 15:32, 18 January 2008 (CST)

but: Schizophrenia and functional polymorphisms in the MAOA and COMT genes: no evidence for association or epistasis. PMID: 12116182 Pierre-Alain Gouanvic 16:52, 18 January 2008 (CST)

still: Efficacy of selegiline add on therapy to risperidone in the treatment of the negative symptoms of schizophrenia: a double-blind randomized placebo-controlled study.... as you said (in an attempt to raise dopaminergic functioning to reduce negative symptoms) Pierre-Alain Gouanvic 17:05, 18 January 2008 (CST)

I added an article on the link between nicotine as an MOAI and schizophrenia. Let me know what you think. Richard Pettitt 17:24, 19 January 2008 (CST)

I provided some details and distinguished nicotine from other psychoactive tobacco components; it gave me the opportunity to mention the use of MAOI in schizophrenia (as you underlined above). I'm going to contact Tom Kelly to let him know that we have followed up on his advice. Pierre-Alain Gouanvic 13:16, 28 January 2008 (CST)

First person account, to fill the gap left by the DSM copyright restriction

Hello,

I wonder if we could use the moving story told by an investigator in the fields of paranoia and schizophrenia research, published in Schizophrenia Bulletin 2007 33(1):166-17: Peer-Professional First-Person Account: Schizophrenia From the Inside—Phenomenology and the Integration of Causes and Meanings, Peter K. Chadwick. See top of page for permissions. Pierre-Alain Gouanvic 19:06, 17 January 2008 (CST)

I think having case studies within mental health articles is a great idea. I'm not sure how we'd use this particular story, however, due to its length. Maybe as a signed article?

I'm going to look to see if I can find any short and concise case studies we can use... Richard Pettitt 13:39, 18 January 2008 (CST) Update: I`ve emailed a professor for use of a case report he wrote... hopefully he gets back to me soon. --Richard Pettitt 10:05, 23 January 2008 (CST)

No first person accounts in the article. I addressed this with Pierre-Alain on another article. --Michael J. Formica 17:12, 27 January 2008 (CST)

I'm sorry, I didn't realize you had made the official policy on this. Could you link to this discussion you're talking about? -Richard Pettitt 17:27, 27 January 2008 (CST)

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I think a well-chosen, brief first person-account (or part of one), particularly an excerpt from one that is well-known, would add a great deal to the article and help "bring it home" to a lot of people. However, I don't think it should be within the main text. Instead, see Butler and scroll down and note the "Sidenotes" there that are separated from the main text. Like I said, I think one brief first-person account, situated like that, would be a very interesting addition to the article. Stephen Ewen 00:33, 29 January 2008 (CST)

I like this suggestion. Since I don't have such an account on hand for this article, I added one at another article I've been working on. If you think that looks decent (feel free to edit the position/colour etc as I took the code straight from the butler article) let me know and I'll make a post on the forum to see what other people think about this kind of content in an article. Thanks. --Richard Pettitt 20:19, 29 January 2008 (CST)

The particular first person account Peer-Professional First-Person Account: Schizophrenia From the Inside—Phenomenology and the Integration of Causes and Meanings strikes me as a bit too atypical. I wonder if there are other options. Your addition to Depersonalization disorder is, I think, a tasteful, well-chosen, and excellent addition. Stephen Ewen 23:17, 29 January 2008 (CST)

Thanks for the comment Stephen. I posted to the forum if you'd like to discuss this further.--Richard Pettitt 13:27, 30 January 2008 (CST)

Image

As an editor, I have taken the liberty of removing the image originally attached in this article. I do not feel it is appropriate, and lacks clinical distance. Comments welcome. --Michael J. Formica 17:14, 27 January 2008 (CST)

Could you explain what you mean by "appropriate", and how a painting could possibly have clinical distance? Had you looked at the origin of the image, you would have found the Public Library of Science - Medicine used the image with the caption: "This painting is frequently used to teach undergraduates what a person with schizophrenia experiences". The peer-reviewers at the PLoS clearly believe it is appropriate, and I do as well.--Richard Pettitt 17:24, 27 January 2008 (CST)

Manifestly, this (pictorial) first-person account, like other first-person accounts, is appropriate. Pierre-Alain Gouanvic 01:02, 28 January 2008 (CST)

That's the point...the picture does not have clincial distance. If you can find a documented reference, rather than a caption in a textbook, I'd be fine with it. --Michael J. Formica 08:10, 28 January 2008 (CST)

I'm not going to press this issue any farther, but I would appreciate if you took a look at the image's source. Thanks. --Richard Pettitt 18:49, 28 January 2008 (CST)

Schizophrenia depicted in art? Of course that is highly relevant to the article here. Part of the power of a wiki is that varied people help bring an interdisciplinary perspective to topics. Refer to the "sidenote" titled "Butlers in art" at Butler for one formatting arrangement for handling Schizophrenia depicted in art. Stephen Ewen 00:52, 29 January 2008 (CST)

To further justify a picture depicting schizophrenia--much of the world's art has been created not solely in purpose but also to express something. Just as it is relevant to show images created by artists while they are medically subjected to LSD or other psychoactive drugs; to document soldiers attempting military drills while on hallucinagens; to record spiders trying to create their webs while induced with alcohol, speed, caffeine and other stimulants it is important enough to grant some kind of visual representation of someone's interpretation who is dealing with a mental disorder. I agree that there is a minor point that perhaps it does not "distance" ones self from the subject, but that point is minor compared to the understanding that may be gained from a special window into a schizophreniac mind. --Robert W King 10:06, 29 January 2008 (CST)

Well, having originally added the image, I still think it should be included. I've put it back it where it was previously, but it doesn't need to be in the lede. If you believe it should be put in a similar sidenote as the Butler article, feel free to do it. I'm not familiar enough with wiki-code to attempt placing the image any other way. :) --Richard Pettitt 15:22, 29 January 2008 (CST)

40's

"although a variant of the disorder, identified clinically as paranoid schizophrenia, typically evidences itself in the early 40's, with little or no demonstrable symptom history."

Two concerns. First, since we're having some disagreement over the word evidence, perhaps we could agree on the word 'manifest'? Secondly, can we get a reference for how the paranoid subtype occurs in the 40's? I'm not familiar with any sources that state this.--Richard Pettitt 17:46, 27 January 2008 (CST)

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Further, as I've noted, the word evidence used here is correct in that it is a verb in clinical jargon. Manifest would work.

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Blessings... --Michael J. Formica 07:58, 28 January 2008 (CST)

substances as risk factor

A risk factor means something has been correlated with the disorder. The literature has been fairly consistent in reporting that the earlier a person begins smoking, and the more they smoke, the more likely they are to develop schizophrenia. Saying cannabis use is a risk factor is not making a causal link.--Richard Pettitt 18:45, 28 January 2008 (CST)

pregnancy / post partum schiz

It is rare, but should we mention it? Tom Kelly 14:40, 28 January 2008 (CST)

cope wording

I don't like the words 'more easily' cope... would 'better cope' be better? Tom Kelly 14:50, 28 January 2008 (CST)

Sure, why not. If someone else feels strongly about it, I'm sure they'll change it.--Richard Pettitt 19:21, 28 January 2008 (CST)

..."identified as..."

That phrase in the lede is needless and rings to me like less than the best way to write it. The Mayo Clinic article on the topic opens, "Schizophrenia is a chronic and often debilitating mental illness." The lede of a PLoS Journal article on the subject: "Schizophrenia is a devastating mental illness...." I think the lede here should read, "Schizophrenia is identified as a mental disorder characterized by patterns of disordered thought, language, motor, and social function." Stephen Ewen 00:26, 29 January 2008 (CST)

I agree, and have changed it as such. While some cultures/religions may see it differently, that information should be considered in another section, not in the lede.--Richard Pettitt 15:10, 29 January 2008 (CST)

Retiring

The open partisanship and failure of academic accumen that I cited to Larry previously remains a thorn in the side of Citizendium, no less so than it does Wikipedia. That is an unfortunate circumstance, but it is a consistent one. That said, I am not only recusing myself from (1) the articles on Schizophrenia, Depersonalization, and Dissociative identity disorder A comment here was deleted by The Constabulary on grounds of making complaints about fellow Citizens. If you have a complaint about the behavior of another Citizen, e-mail constables@citizendium.org. It is contrary to Citizendium policy to air your complaints on the wiki. See also CZ:Professionalism. but (2) retiring from Citizendium altogether, as I view it as an enterprise of noble intention, but failed execution. --Michael J. Formica 11:17, 29 January 2008 (CST)

Paranoid schizophrenia onset in 40's ????

Reading the discussion here pushed me to do some reading. I thought I’d share my findings. I know I am taking up a lot of space and you are all free to remove these extensive comments if you wish.

I was suprised by the statements on the age of onset of paranoid schizophrenia, and its rarity in women. I have been unable to find a basis for these in the literature.This is some of what have found, along with some thoughts. If any of you authors are interested in these papers and do not have access, e-mail me privately and perhaps I can help you gain access.

First off, when it comes to “average age” of onset of schizophrenia, it is very important to specify the exact criteria being used to make the diagnosis. Of course, its always vital to define any population being measured if the measurements values are to be meaningful- but in mental disorders that are identified by behavior, it is particularly easy to mix one diagnosis with another if the basis for giving the diagnosis is not tightly defined. That has been demonstrated, specifically, for schizophrenia. There was a seminal study conducted by WHO that showed if a strict and narrow definition of schizophrenia was used, then the percent of the adult population with schizophrenia was remarkably constant in many diverse locales worldwide, but if strict diagnostic criteria were not given to the WHO surveyors, the incidence of schizophrenia was much, much higher in some countries than others. There are other examples of this kind of reporting bias, and that makes me very skeptical about the rarity of paranoid schizophrenia in women, for example. I do not find this reported in major textbooks and would like to know the evidence for stating it here.

When it comes to the types of schizophrenia (eg paranoid, catatonic etc) , some countries’ clinical systems recognize more types than others. These issues are nicely discussed in the paper: Messias E. Sampaio JJ. Messias NC. Kirkpatrick B. Epidemiology of schizophrenia in northeast Brazil. [Journal Article. Research Support, Non-U.S. Gov't. Research Support, U.S. Gov't, P.H.S.] Journal of Nervous & Mental Disease. 188(2):118-20, 2000 Feb. which also discusses the WHO study that found a constant percentage of schizophrenics country to country.

The strict definition of schizophrenia involves positive factors (such as): the presence of a thought disorder, and negative factors (such as) the abnormal absence of displayed emotion (so-called flat affect).

I think that the notion that paranoid schizophrenia usually has its onset late in life is not true. Schizophrenia is very rare under the age of 10, its onset in usually in adolecsence and early adulthood. It can first occur in middle age, but this unusual. However, there is a different psychiatric disorder that most commonly has an onset late in life, and most commonly includes paranoid thinking – that disorder is called Delusional Disorder.

Delusional disorder is NOT paranoid schizophrenia. It is said that “Delusional disorder usually first appears in middle to late adulthood. The overall prevalence of delusional disorder is slightly higher among women than among men, and the average age of onset is earlier for men (40 to 49 years) than for women (60 to 69 years). Owing to its later age at onset, the lifetime morbidity risk is estimated by DSM-IV-TR to range between 0.05 and 0.1 percent.” (quote from current online edition of Kaplan & Sadock's Comprehensive Textbook of Psychiatry Table of Contents > Volume II > 51 - Geriatric Psychiatry > 51.3 Psychiatric Disorders of Late Life > 51.3g Schizophrenia and Delusional Disorders > DELUSIONAL DISORDER).

Realize that “prevalence” just mean numbers of people, and since there are generally greater numbers of middle aged and elderly females than males, the incidence of the disorder does not have to be higher in females to end up with a prevalence of females.

Delusional disorder is much more common in the elderly than the young.

In delusional disorder, there is no thought disorder and affect is not flat. There are fixed beliefs, like “my wife is trying to poison me”, “my roommate is plotting against me”, etc. This is paranoia, but it IS NOT paranoid schizophrenia. It is not any type of schizophrenia.

However, there are references that indicate paranoid schizophrenia may be more commonly of late onset than other types of schizophrenia IN WOMEN. This is not universally reported and, despite the reference that follows, it is possible that there is some confusion of this diagnosis with delusional disorder:

Status MEDLINE Authors Salokangas RK. Honkonen T. Saarinen S. Authors Full Name Salokangas, Raimo K R. Honkonen, Teija. Saarinen, Soile. Institution Department of Psychiatry, Psychiatric Clinic, Turku University Central Hospital, Turku Mental Health Centre, 20520 Turku, Finland. Raimo.K.R.Salokangas@tyks.fi Title Women have later onset than men in schizophrenia--but only in its paranoid form. Results of the DSP project. Source European Psychiatry: the Journal of the Association of European Psychiatrists. 18(6):274-81, 2003 Oct. Abstract According to the literature, schizophrenia begins in men earlier than in women. It has been argued that the gender-bound age difference is due to the protective antidopaminergic effect of estrogens in women. However, the effect of gender on the age of onset may vary between different types of schizophrenias, and can also be modulated by marital status and by age at onset of illness. Comprehensive data were collected on 3306 DSM IIR schizophrenia patients, aged 15-64 years, who had been discharged from psychiatric hospitals in Finland in 1982, 1986 and 1990. The age of onset of illness (AOI) was defined by the age at the first admission (AFA). Male patients were admitted earlier than female patients, and a small second peak in women appeared at the age of 40-44. However, there were no gender differences in AFA within diagnostic subgroups, except in paranoid schizophrenia in which AFA was lower in men than in women even when marital status was taken into account. Within paranoid schizophrenia, this effect of gender was significant only in those of the patients whose AFA was higher than 30 years. It is suggested that there is no gender difference in AOI in early onset schizophrenia. In later onset, paranoid schizophrenia, the illness seems to manifest in women later than in men. Publication Type Comparative Study. Journal Article. Research Support, Non-U.S. Gov't.

Here are additional references for those who are interested:

Copeland JRM, Dewey ME, Scott A, Gilmore C, Larkin BA, Cleave N, McCracken CFM, McKibbin PE: Schizophrenia and delusional disorder in older age: community prevalence, incidence, comorbidity and outcome. Schizophr Bull. 1998;19:153.

Flint AJ, Rifat SI, Eastwood MR: Late-onset paranoia: distinct from paraphrenia? Int J Geriatr Psychiatry. 1991;6:103.

Friedman JI, Harvey PD, Coleman T, Moriarty PJ, Bowie C, Parrella M, White L, Alder D, Davis KL: Six-year follow-up study of cognitive and functional status across the lifespan in schizophrenia: a comparison with Alzheimer's disease and normal aging. Am J Psychiatry. 2001;158:1441.

Howard R, Rabins PV, Seeman MV, Jeste DV, and the International Late-Onset Schizophrenia Group: Late-onset schizophrenia and very-late-onset schizophrenia-like psychosis: an international consensus. Am J Psychiatry. 2000;157:172.

Ostling S, Skoog I: Psychotic symptoms and paranoid ideation in a nondemented population-based sample of the very old. Arch Gen Psychiatry. 2002;59:53.

Riechler-Rossler A, Loffler W, Munk-Jorgensen P: What do we really know about late-onset schizophrenia. Eur Arch Psychiatry Clin Neurosci. 1997;247:195. ...said Nancy Sculerati (talk) (Please sign your talk page posts by simply adding four tildes, ~~~~.)

Hi Nancy. Be assured your comments are very welcome here, and I'm glad to get the perspective of an MD on the relevant literature. Please don't think I'm ignoring your work, but "real world" issues are taking precedence. As soon as I have time, your findings will do much to improve the article. Thanks again! --Richard Pettitt 15:50, 3 February 2008 (CST)